Adult Questionnaire

Monitoring Data Collection Tools for the Minority AIDS Initiative (MAI)

Documents and Forms

Document Name Document Type
Form MAI Adult Question Adult Questionnaire Form and Instruction
MAI Adult Question MAI Adult Questionnaire 2024 MAIAdultQuestionnaire2024.docx Form and Instruction
MAI Adult Question MAI Adult Questionnaire 2024 MAIAdultQuestionnaire2024.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Adult Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	MAI Adult Questionnaire 2024	MAI Adult Questionnaire 2024	MAIAdultQuestionnaire2024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	4,000	4,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.